Change of sensing vector in the subcutaneous ICD during follow‐up and after device replacement

Bettin, Markus; Rath, Benjamin; Ellermann, Christian; Leitz, Patrick; Bögeholz, Nils; Reinke, Florian; Köbe, Julia; Eckardt, Lars; Frommeyer, Gerrit

doi:10.1111/jce.13647

Cited by 8 publications

(8 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…During follow‐up of patients with an S‐ICD, it is not uncommon to find sensing‐related issues (either undersensing or oversensing) that, in many cases, are amenable to correction through programming without the need for surgical revision or removal of the device, provided adequate alternative sensing vectors are available . In this regard, our observation of a significant increase in the percentage of patients with more than one suitable vector with a combined LPES and RPES approach could eventually translate into improved clinical results and a reduction of sensing‐related adverse outcomes.…”

Section: Discussionmentioning

confidence: 90%

“…In this regard, our observation of a significant increase in the percentage of patients with more than one suitable vector with a combined LPES and RPES approach could eventually translate into improved clinical results and a reduction of sensing‐related adverse outcomes. In that scenario, when a sensing problem occurs, a manual change in the selected sensing vector can solve the problem in many patients . Implanting the S‐ICD lead on the side of the sternum showing more suitable vectors at preimplantation screening may potentially lead to a reduction in inappropriate therapy rates and the need for surgical revision or system removal.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Impact of routine right parasternal electrocardiographic screening in assessing eligibility for subcutaneous implantable cardioverter‐defibrillator

Arias

Pachón

Sánchez-Iglesias

et al. 2019

Cardiovasc electrophysiol

View full text Add to dashboard Cite

Introduction: Between 7% and 15% of patients with an indication for an implantable cardioverter-defibrillator (ICD) are not eligible for implantation of a subcutaneous implantable cardioverter-defibrillator (S-ICD) on the basis of the result of the conventional left parasternal electrocardiographic screening (LPES). Our objective was to determine the impact of systematically performing right parasternal electrocardiographic screening (RPES) in addition to conventional LPES, in terms of increasing both the total percentage of potentially eligible patients for S-ICD implantation and the number of suitable vectors per patient. Methods and results: Consecutive patients from the outpatient device clinic who already had an implanted ICD, and no requirement for pacing were enrolled. Conventional left parasternal electrode position and right parasternal electrode positions were used. The automatic screening tool was used to analyze the recordings. Screenings were performed in the supine and standing positions.Overall, 209 patients were included. The mean age was 63.4 ± 13 years, 59.8% had ischemic heart disease, mean QRS duration was 100 ± 31 ms, and 69.9% had a primary prevention ICD indication. Based on conventional isolated LPES, 12.9% of patients were not eligible for S-ICD compared with 11.5% based on RPES alone (P = .664).Considering LPES and RPES together, only 7.2% of patients were not eligible for S-ICD (P < .001). Moreover, the number of patients with more than one suitable vector increased from 66.5% with isolated LPES to 82.3% (23.7% absolute increase [P < .001]). Conclusion: Adding an automated RPES to the conventional automated LPES increased patient eligibility for the S-ICD significantly. Moreover, combined screening increased the number of suitable vectors per eligible patient. K E Y W O R D S automated electrocardiographic screening, electrocardiography, inappropriate shocks, subcutaneous defibrillator, sudden cardiac death How to cite this article: Arias MA, Pachón M, Sánchez-Iglesias I, et al. Impact of routine right parasternal electrocardiographic screening in assessing eligibility for subcutaneous implantable cardioverter-defibrillator.

show abstract

Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Impact of routine right parasternal electrocardiographic screening in assessing eligibility for subcutaneous implantable cardioverter‐defibrillator

Arias

Pachón

Sánchez-Iglesias

et al. 2019

Cardiovasc electrophysiol

View full text Add to dashboard Cite

show abstract

“…One such mechanism lies in the change in sensing vector owing to shifts in device position. 8 This may occur as a result of change in patient position or significant weight change, or during exercise, and may be avoided with reassessment of the automatic setup, such as in significant body habitus changes, assessment in different patient positions, etc. 8 , 9 Another mechanism for vector change may be from changes in myocardial vascularization, as tissue ischemia and different forms of cardiomyopathy may cause dynamic changes in the sensed vectors and/or QRST complexes of patients.…”

Section: Discussionmentioning

confidence: 99%

Vector configuration screening failure after defibrillation threshold testing: Should we be concerned?

Uzunoglu¹,

Liu²,

Adrover³

et al. 2023

HeartRhythm Case Reports

View full text Add to dashboard Cite

“…An der randomisierten Vergleichsstudie zum transvenösen ICD, die 2021 eine Nichtunterlegenheit des S‑ICD zeigte, nahmen mehrere deutsche Zentren teil (Mannheim, Kiel, München, Leipzig; [ 30 ]), auch an dem großen europäischen Register EFFORTLESS [ 31 ]. Es erfolgten zahlreiche deutsche Forschungsbeiträge, u. a. aus Düsseldorf zur Operationstechnik [ 32 ], aus Münster zur Zuverlässigkeit des Sensings [ 33 ] und aus Mannheim zur Kombination mit anderen implantierten Geräten wie Schrittmachern [ 34 ]. Einer der bekanntesten Experten auf dem Gebiet der S‑ICD-Technologie und Implantationstechnik wurde der Herzchirurg Joachim Winter aus Düsseldorf.…”

Section: Entwicklung Des Subkutanen Icd (S-icd) Als Alternative Sowie...unclassified

Die Geschichte des implantierbaren Kardioverter-Defibrillators in Deutschland

Block,

Klein

2024

Herzschr Elektrophys

View full text Add to dashboard Cite

ZusammenfassungDer implantierbare Kardioverter-Defibrillator (ICD) war ein Durchbruch in der Prävention des plötzlichen Herztodes. Nach jahrelanger technischer Entwicklung durch Michel Mirowski erfolgten trotz vieler Widerstände in den USA 1980 erste Implantationen. Es konnte gezeigt werden, dass Kammerflimmern zuverlässig durch den ICD automatisch erkannt und defibrilliert wurde. Knapp 4 Jahre nach den USA begannen mehrere Zentren, in Deutschland ICDs zu implantieren. Bald wurden außerhalb der USA in Deutschland die meisten Patienten versorgt. Die absolute Zahl der Implantationen war weiterhin klein, solange nur Implantationen mittels Thorakotomie und epikardialen Defibrillationselektroden möglich waren. Anfang der 1990er Jahre konnte ein ICD pektoral, wie ein Schrittmacher, in Kombination mit einer transvenösen Defibrillationselektrode implantiert werden. Die Implantationszahlen stiegen sprunghaft an. Die klinische Forschung in Deutschland begleitete die technischen Fortentwicklungen und hier erfolgten viele First-in-human-Studien. In den USA und Deutschland wurden 1991 erste Leitlinien zur Indikation herausgegeben. Randomisierte Studien zur Mortalität, zumeist unter amerikanischer Leitung mit deutscher Beteiligung, aber auch unter deutscher Leitung (CASH, CAT, DINAMIT, IRIS), wurden zwischen 1996 und 2009 publiziert. Die Ergebnisse dieser lang zurückliegenden Studien wurden 2016 in Frage gestellt, als die DANISH-Studie keine signifikante Verbesserung der Mortalität ergab. Die Implantationszahlen sind seitdem rückläufig. Derzeit wird daran geforscht, genau die Patienten zu versorgen, die trotz optimaler Therapie vor dem plötzlichen Herztod geschützt werden müssen. Risikoscores unter Einbeziehung myokardialer Narben in der Magnetresonanztomographie (MRT) und genetischer Information sollen hierzu beitragen.

show abstract

Change of sensing vector in the subcutaneous ICD during follow‐up and after device replacement

Cited by 8 publications

References 20 publications

Impact of routine right parasternal electrocardiographic screening in assessing eligibility for subcutaneous implantable cardioverter‐defibrillator

Impact of routine right parasternal electrocardiographic screening in assessing eligibility for subcutaneous implantable cardioverter‐defibrillator

Vector configuration screening failure after defibrillation threshold testing: Should we be concerned?

Die Geschichte des implantierbaren Kardioverter-Defibrillators in Deutschland

Contact Info

Product

Resources

About